This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Friday, 8 October 2010

Holy Shit

Not content with forcing RNs to take on more patients than they can handle, recruitment freezes, pay freezes, and hellish working conditions that would cause most people to collapse from sheer fucking exhaustion the powers that be have come up with a new plan.

Already the working conditions are so chaotic that it is usually impossible for the RN's on my type of ward to take breaks. We stay over late at the end of a 12 hour shift unpaid and still cannot manage to keep up with paperwork. We do the jobs of pharmacy, portering, social services etc and are held accountable for their faults.

But I guess that is just not enough. I will post the entire article here.

Nurses told to work for free to save their jobs

By Ryan Crighton and Catriona Webster
Published: 06/10/2010

Nurses are being asked to work extra shifts for free to save their jobs – as health boards across Scotland spend up to £30million hiring agency staff. Almost 4,000 NHS jobs, including more than 1,500 nursing and midwifery posts, will be axed this year due to cutbacks, according to Health Secretary Nicola Sturgeon.
But last night it emerged that the country’s 14 health boards have set aside a combined £30million for temporary nurses and theatre staff over the next four years.

NHS Grampian hopes to save £385,000 by asking staff at Aberdeen Royal Infirmary’s surgical unit to take on one more shift each month – for no extra money.

The agency staff contract, which has just been awarded, will see nine firms provide workers to fill staffing gaps as health boards – including NHS Tayside and NHS Highland – deal with the spending crisis in the public sector.

The contract will last for two years, with the option of extending it for two more.

Last night the Royal College of Nursing (RCN) Scotland raised fears that the deal could reverse efforts to cut reliance on agency workers.

RCN associate director Norman Provan said: “Nursing teams have led the way in recent years by changing the way in which their work is managed so that reliance on costly agency staff has been reduced. As health boards cut costs by not replacing staff when they leave, we will be monitoring them to ensure they do not reverse the trend of recent years and begin relying too heavily on agency nursing to fill the gaps.

“If health boards do realise that they need to fill the gaps created by their unsustainable cost-cutting tactics, they must recruit additional permanent staff in the best interests of patient care.”

Labour shadow cabinet member Richard Baker added: “It looks like different parts of the NHS are not talking to each other. When NHS Scotland is spending £30million on a contract to provide agency nurses it seems ridic-ulous that NHS Grampian is asking their nurses to work an extra shift for nothing.”

An Aberdeen company is one of the nine firms which will share the contract. H1 Healthcare Solutions – which trades as PCSG Healthcare – said it could take on up to 250 health workers during the duration of the deal.

An NHS Scotland spokes-man said the contract replaced an agreement which was about to expire. He said the number of agency nurses being used was falling, and that trend would continue.

He added: “Whilst agencies will always have a role in providing supplementary staff, this only supplements internal efforts to meet the staffing requirements.”

The RCN has also voiced concerns about NHS Grampian’s plans to share an extra 188 12-hour shifts between its nurses. It is understood that nurses in the surgical unit at ARI would receive an extra 15 minutes unpaid break per day to compensate for the extra shift.

One angry ARI nurse, who did not want to be named, said: “Everyone is unhappy about these changes. We’ve been asked to meetings but the feeling is: if we contest it, they won’t care. We’ve been given 90 days to comply.

“They are trying to save money but the added pressure is all on the nurses, it’s coming out of our pockets. We are being asked to work for nothing.”

Another said: “The thing the nurses are worried about is patient care. We already have skeleton staffs because of the recruitment freeze, so we don’t get our breaks.”

Colin Poolman, the RCN’s local officer for Grampian, said members were furious about the plans. “This change in working arrangements is clearly to the detriment of our hard-working and over-stretched members who are bearing the brunt of the cuts being made by NHS Grampian,” he said.

Tory health spokeswoman and Highland MSP Mary Scanlon said the plans were the first time she had ever heard of a public body asking staff to work for free.

A spokesman for NHS Grampian said the measures will help secure jobs.

He said: “The proposal is to move from 13 to 14 shifts in a month in the surgical one division of ARI. It will potentially save £385,000 which is very important in the current financial climate. The alternative would be to employ fewer staff.”

The fuckers can have my job. Fuck them. I'd also like to point out something. When we do get agency Nurses in from the outside it is a disaster. A Nurse simply cannot handle taking on a massive patient load on an acute ward unless she is there all the time. It is like running. If you stop training for that marathon, you just won't be able to keep up. We have had a few disasters lately at my trust because of agency Nurses getting thrown in as the only qualified.

Meanwhile back in my neck of the woods the matrons are threatening ward staff nurses with sacking if we don't get our fingers out and make sure that the insane amounts of ridiculous paperwork is completed. According to them, any bad care that occurs is a result of Nurses not doing paperwork.

I recently had a patient fall out of bed. I wasn't watching him at the time because I had two other bays of patients and a side room. I was also running around the hospital looking for the "bed rail assessment" paperwork forms to fill in for him so that I don't get sacked. You would think that if they want us to fill in these forms like they are holy then they would provide each ward with enough of the actual forms.

When one of my colleagues didn't complete her paperwork because there was none on the ward she was told that she should have left her patients and searched the other wards in the hospital. Not something that one can do if she is the only RN for 15 patients.
Bastards.

What are we? Fucking Slaves? The government is cutting pay, cutting jobs, and cutting benefits for people from whom they take the pay and jobs. I suppose soon they will be counting us as 3/5 of a human being and loaning us Nurses out to work for other trusts for a fee. And they will line their pockets with that fee.

Seriously guys if they get away with this shit things are going to SNOWBALL. It seems like we won't be eating if we don't put up with slave like conditions, and having recently worked a 14 hour shift without being able to take a break I am really feeling a bit like I am not considered fully human. Maybe just 3/5 of one.
Thanks to grumpyRN for alerting me to this story anyway.

18 comments:

Thank you Anne, you have given this a bigger circulation than I can. Hopefully between us it will get picked up and this nonsense will be stopped. I would like to add, I don't work in Aberdeen or for NHS Grampian but I find this shit appalling and think if it catches on then where will they do it next?

Glad you are back Anne.Your blog provides such a useful source of information and comment. While horrified, I feel committed to making sure nursing staff I come across are trested fairly...that seems all I can do as a regular member of the public.

Our powers that be have a cunning plan . . . currently we work 7.5 hour shifts. They plan to cut that to 7 hours by cutting handover periods and then we can work an extra day or three a month for all those .5 hours they have "saved"

They want us to hand over 35 patients to the next shift in 15 minutes as well. And they won't do anything about the constant interruptions via phone, relatives, visitors, doctors, pharmacy, patients etc either.

What they could do is give us more nurses so we are each handing over a smaller number of patients or at least give us a ward clerk at handover times to deal with the constant ringing phone that the care assistants won't answer.....but noooooooooooo

Hi AnneSounds like very DIM management here - let's hope they are their legal departments are aware of this ridiculous proposal. This has been mooted in the past - a decade or so ago and never got anywhere. A few factors for a brain dead management numpty/ies is to consider eg nurses have mortgages to pay, petrol + child care costs + any other costs, 2 days extra off in lieu.They can ask but there generally is nowt for nowt.Glad your back.Anna

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.